Three years ago 5% of hospitals were in financial deficit - this has risen to 90%.

Missed A&E waiting time targets have gone from 10% to 90% in the same period.

Hopson called for “an open, honest, realistic, national debate on what gives” if no more money is made available to health trusts in the Chancellor’s Autumn Statement on November 23, reports the Press Association.

He told the paper: “Thanks to the dedication of staff, NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell.

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“But NHS trust bosses are now ringing that bell – we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate.

“Trusts will, of course, do all they can to deliver efficiency savings and productivity improvements. But they are now saying it is impossible to provide the right quality of service and meet performance targets on the funding available.”

It also sits against a background of junior doctors planning week-long walkouts in October, November and December in protest over a new contract.

Hopson, whose organisation is the trade association for acute hospital, ambulance, community and mental health services in the NHS, suggested that if there is no more money available it could lead to rationing of care, shutting down some services, formally relaxing performance targets, increasing charges, and “more explicitly controlling the size of the NHS workforce”.

He added: “These are all approaches adopted by other public services such as prisons, local government and the police when faced with similar funding challenges over the past decade – though they would clearly provoke public unease and ministerial anxiety if applied to the NHS.”

A Department of Health spokesman told the newspaper: “We know the NHS is under pressure because of our ageing population, but we rightly expect the service to continue to ensure that patients get treated quickly.”